Side effects | NSAR and Novalgin® – is it compatible?

Side effects

An advantage of using Novalgin® in contrast to typical NSAIDs (such as acetylsalicylic acid) is that it is very well tolerated by the stomach and peptic ulcers practically never occur. More frequent, however, are severe drops in blood pressure when injected too quickly. A side effect of Novalgin® is the so-called Agranulocytosis.

This is a dangerous disturbance of the white blood cells (more precisely: the granulocytes) in the bone marrow. Symptoms of agranulocytosis can be fever, chills, local and later generalized infections (sepsis). However, the frequency of agranulocytosis with the administration of Novalgin® is controversially discussed, it seems to be a very rare complication.

Overall, Novalgin® seems to be even better tolerated than the more commonly used non-steroidal anti-inflammatory drugs (NSAIDs). Nevertheless, Novalgin® is not approved in some countries including Sweden, England and the USA due to the risk of developing agranulocytosis. In Germany, Austria, Switzerland and other countries Novalgin® and the active ingredient Metamizol are used very frequently, especially for coli-related pain. Novalgin® is available only on prescription in Germany. Novalgin® is the most pain-relieving drug among the weak analgesics (i.e. non-opioid analgesics).If other weaker drugs like NSAIDs or paracetamol are not sufficient or cannot be used, Novalgin® is a proven painkiller.

Interaction between Novalgin® and NSAID

Novalgin® is a drug containing the active ingredient metamizole. Novalgin® belongs to the group of pyrazolones, which have analgesic and antipyretic effects. Metamizole, and thus also Novalgin®, is available only on prescription and may only be taken under medical advice.

NSAIDs or non-steroidal anti-inflammatory drugs are also drugs that have an anti-inflammatory and antipyretic effect. They belong to the group of non-opioid analgesics. Aspirin, Ibuprofen and Diclofenac belong to the group of NSAIDs.

The active ingredient of Novalgin®, metamizole, is a non-selective cyclooxygenase inhibitor. It has an inhibitory effect on prostaglandin synthesis. Prostaglandins play an important role in the transmission of pain and hormones.

Aspirin, which belongs to the group of NSAIDs, has acetylsalicylic acid, also known as ASS, as its active ingredient. Similar to the effect of metamizole, ASA is based on an irreversible inhibition of cyclooxygenases. ASS also inhibits the formation of thromboxane which reduces the risk of thrombosis.

This antithrombotic effect is mainly used in elderly patients and for heart attack prophylaxis. Metamizole is often used for acute and chronic pain. Chronic pain in particular often occurs in patients with co-morbidity (additional occurrence of diseases in addition to an underlying disease) or in patients of advanced age.

These patients also often have an increased cardiovascular problem and are often in long-term treatment with ASA. Since both the active ingredient metamizole and ASA act on the cyclooxygenases, Novalgin® may inhibit the binding of ASA to the platelet COX-1 (cyclooxygenase). As a result, the thrombocyte aggregation inhibition of aspirin can be completely inhibited or reduced, which means that aspirin is no longer a reliable thrombosis prophylaxis. You should be cautious when taking Novalgin® if you have previously had an intolerance to other painkillers such as diclofenac or ibuprofen. You should stop taking Novalgin® immediately if you experience agranulocytosis (decrease in white blood cells) or thrombocytopenia (decrease in platelets).